New: EpiFix for chronic wounds
EpiFix (MiMedx) amniotic membrane allograft is made of dehydrated human amnion/chorion membrane tissue (dHACM). The tissue is derived from amniotic membranes donated with informed consent in the US. EpiFix is terminally sterilised to reduce virus transmission. It is promoted to enhance wound healing, reduce scar tissue formation and modulate inflammation.
EpiFix is indicated for a wide range of wounds; the scope of this briefing is chronic difficult-to-heal wounds including diabetic foot ulcers, venous leg ulcers, arterial ulcers and pressure ulcers.
The company's instructions for use recommend weekly administration. After wound cleaning and debridement in a non-infected wound, EpiFix is removed from the packaging and cut to fit the size of the wound. After EpiFix is applied, a non-adherent contact layer should be placed on top and the wound dressed as usual. EpiFix can be used alongside compression, offloading, negative pressure and hyperbaric oxygen therapy.
The innovative aspect of EpiFix is that it is an allograft of human amniotic membrane that has been processed and purified for use (using the MiMedx proprietary PURION process). This is designed to preserve bioactive components and deliver non-viable cells, multiple extracellular matrix (ECM) proteins, active growth factors, cytokines, chemokines and other specialty proteins present in amniotic tissue with the aim of helping to regenerate soft tissue.
Showing posts with label therapy. Show all posts
Showing posts with label therapy. Show all posts
Wednesday, 31 January 2018
Intrabeam radiotherapy system for adjuvant treatment of early breast cancer [TA 501]
New: Technology appraisal guidance
The Intrabeam radiotherapy system (Carl Zeiss UK) is a mobile irradiation system. It is designed to deliver a single dose of targeted low-energy radiation (X‑rays) directly to the tumour bed, while limiting the exposure of healthy tissue to radiation. Because it delivers low energy radiation, it can be used in an ordinary operating theatre at the time of surgery. The Intrabeam radiotherapy system provides a source of 50 kV energy from a spherical applicator of between 1.5 cm and 5.0 cm diameter. The applicator is sutured to the tumour bed so that breast tissue at risk of local recurrence receives the prescribed dose while skin and deeper structures are protected. Radiation is delivered over 20 to 30 minutes.
The Intrabeam radiotherapy system was granted a CE (Conformité Européene) mark in 1999 for use in radiotherapy.
Intrabeam can be used as an intraoperative radiotherapy system given as the sole treatment or as a boost treatment followed by external beam radiotherapy (EBRT). When intraoperative radiotherapy is given as a boost treatment with Intrabeam and followed by EBRT, there is no need for further external boost treatment. Six NHS centres in the UK have used Intrabeam for adjuvant treatment of early breast cancer.
The Intrabeam radiotherapy system (Carl Zeiss UK) is a mobile irradiation system. It is designed to deliver a single dose of targeted low-energy radiation (X‑rays) directly to the tumour bed, while limiting the exposure of healthy tissue to radiation. Because it delivers low energy radiation, it can be used in an ordinary operating theatre at the time of surgery. The Intrabeam radiotherapy system provides a source of 50 kV energy from a spherical applicator of between 1.5 cm and 5.0 cm diameter. The applicator is sutured to the tumour bed so that breast tissue at risk of local recurrence receives the prescribed dose while skin and deeper structures are protected. Radiation is delivered over 20 to 30 minutes.
The Intrabeam radiotherapy system was granted a CE (Conformité Européene) mark in 1999 for use in radiotherapy.
Intrabeam can be used as an intraoperative radiotherapy system given as the sole treatment or as a boost treatment followed by external beam radiotherapy (EBRT). When intraoperative radiotherapy is given as a boost treatment with Intrabeam and followed by EBRT, there is no need for further external boost treatment. Six NHS centres in the UK have used Intrabeam for adjuvant treatment of early breast cancer.
Minimally invasive percutaneous nephrolitholapaxy medium (MIP-M) for removing kidney stones [MIB 138]
New: Medtech innovation briefing
MIP‑M (Karl Storz, Germany) is a device used to remove kidney stones. MIP‑M is a miniaturised version of percutaneous nephrolithotomy (PCNL) and is suitable for people with kidney stones 12 to 24 mm in diameter in any renal calyx or in the renal pelvis. This device can be used on larger stones but this could increase the operative time and chances of complications. The MIP‑M device comprises a 12 Fr nephroscope, a 16.5/17.5 Fr operating nephrostomy or Amplatz sheath, a single-step dilator and grasping forceps.
The procedure is done by making a small incision, usually in the patient's back, and a needle is inserted into the renal pelvis. The position of the needle is confirmed by X‑ray or ultrasound. A guide wire is placed through the needle into the renal pelvis. It is then withdrawn, leaving the guide wire in place. A single-step dilator is passed over the guide wire to widen the access channel and a 16.5/17.5 Fr sheath is introduced. A miniaturised 12 Fr nephroscope is then passed inside the sheath; it allows the surgeon to see the kidney stones. The nephroscope has a channel through which grasping forceps are introduced to remove small stones. Bigger stones may have to be broken up using ballistic lithotripsy or laser treatments before removal. Ultrasound and laser instruments are also passed through the nephroscope channel.
MIP‑M (Karl Storz, Germany) is a device used to remove kidney stones. MIP‑M is a miniaturised version of percutaneous nephrolithotomy (PCNL) and is suitable for people with kidney stones 12 to 24 mm in diameter in any renal calyx or in the renal pelvis. This device can be used on larger stones but this could increase the operative time and chances of complications. The MIP‑M device comprises a 12 Fr nephroscope, a 16.5/17.5 Fr operating nephrostomy or Amplatz sheath, a single-step dilator and grasping forceps.
The procedure is done by making a small incision, usually in the patient's back, and a needle is inserted into the renal pelvis. The position of the needle is confirmed by X‑ray or ultrasound. A guide wire is placed through the needle into the renal pelvis. It is then withdrawn, leaving the guide wire in place. A single-step dilator is passed over the guide wire to widen the access channel and a 16.5/17.5 Fr sheath is introduced. A miniaturised 12 Fr nephroscope is then passed inside the sheath; it allows the surgeon to see the kidney stones. The nephroscope has a channel through which grasping forceps are introduced to remove small stones. Bigger stones may have to be broken up using ballistic lithotripsy or laser treatments before removal. Ultrasound and laser instruments are also passed through the nephroscope channel.
Friday, 26 January 2018
Management of Infants born to Mothers who have used Opioids during Pregnancy
The incidence of infant opioid withdrawal has grown rapidly in many countries, including Canada, in the last decade, presenting significant health and early brain development concerns. Increased prenatal exposure to opioids reflects rising prescription opioid use as well as the presence of both illegal opiates and opioid-substitution therapies. Infants are at high risk for experiencing symptoms of abstinence or withdrawal that may require assessment and treatment.
This practice point focuses specifically on the effect(s) of opioid withdrawal and current management strategies in the care of infants born to mothers with opioid dependency.
Thursday, 11 January 2018
Travel with CPAP machines: how frequent and what are the problems?
Obstructive sleep apnoea syndrome is a common condition for which continuous positive airways pressure (CPAP) is the standard treatment. The condition affects a population of which a substantial proportion will be travelling. We use a questionnaire survey of CPAP users to gain understanding regarding the behaviours, attitudes and problems surrounding travel with CPAP machines during travel and while abroad.
UHCW Research: Richard Bodington
UHCW Research: Richard Bodington
Pathogenesis and Management of Adiposity and Insulin Resistance in Polycystic Ovary Syndrome (PCOS)
In: Freemark M. (eds) Pediatric Obesity. Contemporary Endocrinology. Humana Press, Cham
Polycystic ovary syndrome (PCOS) is a common condition that often presents during adolescence with characteristic reproductive and hyperandrogenic features. Activation of the hypothalamic-pituitary (HP)-adrenal and HP-ovarian axes during adolescence often coexists with weight gain and heightened insulin resistance; PCOS manifests in those girls who are genetically predisposed. The association of PCOS (the subgroup with both oligo-amenorrhoea and hyperandrogenic features) with metabolic dysfunction, although not contributory as a diagnostic feature, deserves particular focus in adolescent girls. Given the increased risks for development of type 2 diabetes mellitus and dyslipidaemia, it is important that screening for metabolic dysfunction is applied, that “metabo-vigilance” is maintained, and that any emergent metabolic risk factor is managed accordingly. Weight loss remains the most important strategy for both prevention and management of PCOS in obese adolescent girls. With the burgeoning obesity epidemic, it is incumbent upon all of us to promote a healthy lifestyle amongst our children, to avoid excessive weight gain and the associated obesity-related morbidities such as PCOS.
UHCW Research: Thomas M Barber
Polycystic ovary syndrome (PCOS) is a common condition that often presents during adolescence with characteristic reproductive and hyperandrogenic features. Activation of the hypothalamic-pituitary (HP)-adrenal and HP-ovarian axes during adolescence often coexists with weight gain and heightened insulin resistance; PCOS manifests in those girls who are genetically predisposed. The association of PCOS (the subgroup with both oligo-amenorrhoea and hyperandrogenic features) with metabolic dysfunction, although not contributory as a diagnostic feature, deserves particular focus in adolescent girls. Given the increased risks for development of type 2 diabetes mellitus and dyslipidaemia, it is important that screening for metabolic dysfunction is applied, that “metabo-vigilance” is maintained, and that any emergent metabolic risk factor is managed accordingly. Weight loss remains the most important strategy for both prevention and management of PCOS in obese adolescent girls. With the burgeoning obesity epidemic, it is incumbent upon all of us to promote a healthy lifestyle amongst our children, to avoid excessive weight gain and the associated obesity-related morbidities such as PCOS.
UHCW Research: Thomas M Barber
Friday, 5 January 2018
Giving oxygen routinely after a stroke does not improve outcomes
There was no benefit to routinely giving oxygen to people who have had a stroke. Oxygen given continuously, or just overnight, did not reduce disability or death and it did not improve people’s ability to do everyday tasks or live independently. There were no oxygen-related adverse events reported.
Strokes occur when the blood supply to the brain is disrupted by either a blocked or burst blood vessel. They can lead to death or disability as parts of the brain are deprived of blood. Therefore, giving oxygen to reduce the potential damage may appear to make sense.
Guidelines from NICE and the British Thoracic Society recommend that people are not routinely given oxygen after a stroke unless their oxygen levels drop. This large NIHR funded trial provides evidence to support these recommendations and reinforces the need to monitor oxygen levels to guide the appropriate use of oxygen therapy on an individual basis. Given the size and quality of this UK-based trial, it is unlikely that future research would change these recommendations.
From the NIHR Dissemination Centre
Strokes occur when the blood supply to the brain is disrupted by either a blocked or burst blood vessel. They can lead to death or disability as parts of the brain are deprived of blood. Therefore, giving oxygen to reduce the potential damage may appear to make sense.
Guidelines from NICE and the British Thoracic Society recommend that people are not routinely given oxygen after a stroke unless their oxygen levels drop. This large NIHR funded trial provides evidence to support these recommendations and reinforces the need to monitor oxygen levels to guide the appropriate use of oxygen therapy on an individual basis. Given the size and quality of this UK-based trial, it is unlikely that future research would change these recommendations.
From the NIHR Dissemination Centre
Thursday, 4 January 2018
Glyoxalase 1 copy number variation in patients with well differentiated gastro-entero-pancreatic neuroendocrine tumours (GEP-NET)
Oncotarget. 2017 Aug 16;8(44):76961-76973. doi: 10.18632/oncotarget.20290. eCollection 2017 Sep 29.
Background: The glyoxalase-1 gene (GLO1) is a hotspot for copy-number variation (CNV) in human genomes. Increased GLO1 copy-number is associated with multidrug resistance in tumour chemotherapy, but prevalence of GLO1 CNV in gastro-entero-pancreatic neuroendocrine tumours (GEP-NET) is unknown.
Conclusions: GLO1 copy-number was increased in a large percentage of patients with GEP- NET and correlated positively with increased Glo1 protein in tumour tissue. Analysis of GLO1 copy-number variation particularly in patients with midgut NET could be a novel prognostic marker for tumour progression.
Background: The glyoxalase-1 gene (GLO1) is a hotspot for copy-number variation (CNV) in human genomes. Increased GLO1 copy-number is associated with multidrug resistance in tumour chemotherapy, but prevalence of GLO1 CNV in gastro-entero-pancreatic neuroendocrine tumours (GEP-NET) is unknown.
Conclusions: GLO1 copy-number was increased in a large percentage of patients with GEP- NET and correlated positively with increased Glo1 protein in tumour tissue. Analysis of GLO1 copy-number variation particularly in patients with midgut NET could be a novel prognostic marker for tumour progression.
UHCW Research: Kaltsas G, James S, Gopalakrishnan K, Fisk A, Dimitriadis GK, Grammatopoulos DK and Weickert MO
Wednesday, 27 December 2017
Transcutaneous microwave ablation for severe primary axillary hyperhidrosis [IPG601]
New interventional procedures guidance from NICE: Evidence based recommendations on transcutaneous microwave ablation for severe primary axillary hyperhidrosis in adults. Current evidence on the safety and efficacy of transcutaneous microwave ablation for severe primary axillary hyperhidrosis is inadequate in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.
Clinicians wishing to do transcutaneous microwave ablation for severe primary axillary hyperhidrosis should:
Clinicians wishing to do transcutaneous microwave ablation for severe primary axillary hyperhidrosis should:
- Inform the clinical governance leads in their NHS trusts.
- Ensure that patients understand the uncertainty about the procedure's safety and efficacy and provide them with clear written information. In particular, during the consent process patients should be informed about the possibility of nerve damage. In addition, the use of NICE's information for the public is recommended.
- Audit and review clinical outcomes of all patients having transcutaneous microwave ablation for severe primary axillary hyperhidrosis (see section 7.3).
Endobronchial valve insertion to reduce lung volume in emphysema [IPG600]
New interventional procedures guidance from NICE. Endobronchial valve insertion to reduce lung volume in emphysema.
Current evidence on the safety and efficacy of endobronchial valve insertion to reduce lung volume in emphysema is adequate in quantity and quality to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit.
Patient selection should be done by a multidisciplinary team experienced in managing emphysema, which should typically include a chest physician, a radiologist, a thoracic surgeon and a respiratory nurse.
Current evidence on the safety and efficacy of endobronchial valve insertion to reduce lung volume in emphysema is adequate in quantity and quality to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit.
Patient selection should be done by a multidisciplinary team experienced in managing emphysema, which should typically include a chest physician, a radiologist, a thoracic surgeon and a respiratory nurse.
Patients selected for treatment should have had pulmonary rehabilitation. The procedure should only be done to occlude volumes of the lung where there is no collateral ventilation, by clinicians with specific training in doing the procedure.
Monday, 18 December 2017
Effects of a multi-strain probiotic supplement for 12 weeks in circulating endotoxin levels and cardiometabolic profiles of medication naĂŻve T2DM patients: a randomized clinical trial
Journal of Translational Medicine 2017 15:249
The present randomized clinical trial characterized the beneficial effects of a multi-strain probiotics supplementation on improving circulating endotoxin levels (primary endpoint) and other cardiometabolic biomarkers (secondary endpoint) in patients with T2DM.
UHCW Research: Shaun Sabico
The present randomized clinical trial characterized the beneficial effects of a multi-strain probiotics supplementation on improving circulating endotoxin levels (primary endpoint) and other cardiometabolic biomarkers (secondary endpoint) in patients with T2DM.
UHCW Research: Shaun Sabico
A 3D deformable prostate model derived from orthogonal projections of radiotherapy CT data
Poster on a 3D deformable prostate model derived from orthogonal projections of radiotherapy CT data
Modern radiotherapy to the prostate uses daily imaging to track the prostate position and improve targeting accuracy. A 3D flexible model of prostate shape could be used to evaluate such techniques through simulation. Ideally such a model could shape variation during treatment and target definition errors from observer variability.
UHCW Research: J P Sage
Modern radiotherapy to the prostate uses daily imaging to track the prostate position and improve targeting accuracy. A 3D flexible model of prostate shape could be used to evaluate such techniques through simulation. Ideally such a model could shape variation during treatment and target definition errors from observer variability.
UHCW Research: J P Sage
Friday, 15 December 2017
Tonogenchoncel-L (Invossa) Gene Therapy for Regeneration of Cartilage in Patients with Degenerative Arthritis or Osteoarthritis of the Knee
Tonogenchoncel-L is a type of treatment which involves taking cells which make up the cartilage and altering them genetically to help stimulate the growth of the cartilage. These modified cells are injected directly into the knee joint with the intention of helping the lost cartilage regrow. If tonogenchoncel-L was licenced in the UK it could provide a unique treatment for people with knee osteoarthritis which has the potential to help cartilage regrow and improve symptoms.
From NIHR Innovation Observatory
From NIHR Innovation Observatory
Neridronic Acid (Nerixia) for Complex Regional Pain Syndrome
The cause of CRPS is unknown, but it is generally thought to be the result of the body reacting abnormally to an injury. It is difficult to estimate exactly how common CRPS is, as many cases may go undiagnosed or misdiagnosed. Currently there are no approved treatments for CRPS. Neridronic acid administered by injection is currently being developed to treat CRPS and early results indicate that it has the possibility to control the condition. If approved neridronic acid will be a potential new treatment for CRPS.
From NIHR Innovation Observatory
From NIHR Innovation Observatory
Wednesday, 6 December 2017
PO191 Diffuse psoriatic exacerbation following immunoglobulin administration
Association of British Neurologists (ABN) Annual Meeting 20172,3–5th May 2017 ACC, Liverpool
We report the first case of a widespread, exfoliative and erythematous psoriatic exacerbation following immunoglobulin administration. Serious dermatological complications should be considered in patients with pre-existing psoriasis prior to immunoglobulin administration.
UHCW Research: Fizzah Ali, Akram A Hosseini and Antony Thomas
We report the first case of a widespread, exfoliative and erythematous psoriatic exacerbation following immunoglobulin administration. Serious dermatological complications should be considered in patients with pre-existing psoriasis prior to immunoglobulin administration.
UHCW Research: Fizzah Ali, Akram A Hosseini and Antony Thomas
PO199 An autoimmune cranial and peripheral polyneuropathy with myositis
Association of British Neurologists (ABN) Annual Meeting 20172,3–5th May 2017 ACC, Liverpool
A 69 year old man presented in 2006 with diplopia, facial weakness, bulbar dysfunction, profound sensory motor neuropathy (distally more than proximally), and hyporeflexia. Blood at the time did not reveal any major abnormalities. Electrophysiology confirmed severe sensory and motor axonal polyneuropathies. Sural nerve biopsy was non-specific, whereas muscle biopsy specifically showed peri-vascular inflammatory cells. Following significant improvement with intra-venous methylprednisolone, he returned to a functional independent life. More debilitating similar episodes recurred six and nine years later with involvement of cranial nerves 2–7, 9–12, accompanied by predominantly upper limb weakness and hyporeflexia. Post-contrast neural MR and CSF constituents remained normal (negative antiganglioside antibodies). Electrophysiology confirmed progressive axonal peripheral polyneuropathy. Liver biopsy ruled out cirrhosis/autoimmune hepatitis. In 2016, repeat Ro antibodies were positive, with3-year history of Raynaud’s phenomenon. Patient was treated with immunoglobulin, intravenous Methylprednisolone, followed by oral steroids. Subsequently, intravenous Cyclophosphamide then Mycophenolate with ongoing tapered steroids resulted in good response, despite persistent muscle wasting without fasciculations.
UHCW Research: Akram A Hosseini, Fizzah Ali, Shirish Dubey, and Antony Thomas
A 69 year old man presented in 2006 with diplopia, facial weakness, bulbar dysfunction, profound sensory motor neuropathy (distally more than proximally), and hyporeflexia. Blood at the time did not reveal any major abnormalities. Electrophysiology confirmed severe sensory and motor axonal polyneuropathies. Sural nerve biopsy was non-specific, whereas muscle biopsy specifically showed peri-vascular inflammatory cells. Following significant improvement with intra-venous methylprednisolone, he returned to a functional independent life. More debilitating similar episodes recurred six and nine years later with involvement of cranial nerves 2–7, 9–12, accompanied by predominantly upper limb weakness and hyporeflexia. Post-contrast neural MR and CSF constituents remained normal (negative antiganglioside antibodies). Electrophysiology confirmed progressive axonal peripheral polyneuropathy. Liver biopsy ruled out cirrhosis/autoimmune hepatitis. In 2016, repeat Ro antibodies were positive, with3-year history of Raynaud’s phenomenon. Patient was treated with immunoglobulin, intravenous Methylprednisolone, followed by oral steroids. Subsequently, intravenous Cyclophosphamide then Mycophenolate with ongoing tapered steroids resulted in good response, despite persistent muscle wasting without fasciculations.
UHCW Research: Akram A Hosseini, Fizzah Ali, Shirish Dubey, and Antony Thomas
PO108 Susac syndrome: a case for early, aggressive and sustained treatment
Association of British Neurologists (ABN) Annual Meeting 20172,3–5th May 2017 ACC, Liverpool
We report a case of Susac syndrome, initially suspected to be multiple sclerosis, and advocate diagnostic caution and high suspicion. We describe a successful therapeutic approach comprising corticosteroids, intra-venous immunoglobulin and cyclophosphamide for encephalopathic relapse of Susac syndrome.
UHCW Research: Fizzah Ali, Akram A Hosseini and Antony Thomas
We report a case of Susac syndrome, initially suspected to be multiple sclerosis, and advocate diagnostic caution and high suspicion. We describe a successful therapeutic approach comprising corticosteroids, intra-venous immunoglobulin and cyclophosphamide for encephalopathic relapse of Susac syndrome.
UHCW Research: Fizzah Ali, Akram A Hosseini and Antony Thomas
Is Surgical Clip Placement Necessary in all Breast Cancer Patients Undergoing Neoadjuvant Chemotherapy, and Could This Have Financial Implications for Local Trusts?
International Journal of Surgery , Volume 47 , S20
Several studies have reported the benefits of surgical clip placement for all breast cancer patients undergoing neoadjuvant chemotherapy (NAC). The clips allow tumour localisation and maximise potential for breast-conserving surgery. We audited our data to determine if this approach is clinically necssary, and whether avoiding non-essential clips led to financial savings.
UHCW Research: S. Chambers, E. Griffin, L. Jenkins, S. Ayaani, H. Al-Omishy, S. Robertson, M. Sreenivas, A. Tomlins and K. McEvoy
Several studies have reported the benefits of surgical clip placement for all breast cancer patients undergoing neoadjuvant chemotherapy (NAC). The clips allow tumour localisation and maximise potential for breast-conserving surgery. We audited our data to determine if this approach is clinically necssary, and whether avoiding non-essential clips led to financial savings.
UHCW Research: S. Chambers, E. Griffin, L. Jenkins, S. Ayaani, H. Al-Omishy, S. Robertson, M. Sreenivas, A. Tomlins and K. McEvoy
Tuesday, 5 December 2017
European Respiratory Society statement: diagnosis and treatment of pulmonary disease in α1-antitrypsin deficiency
Eur Respir J. 2017 Nov 30;50(5). pii: 1700610. doi: 10.1183/13993003.00610-2017
α1-antitrypsin deficiency (AATD) is the most common hereditary disorder in adults. It is associated with an increased risk of developing pulmonary emphysema and liver disease. The pulmonary emphysema in AATD is strongly linked to smoking, but even a proportion of never-smokers develop progressive lung disease. A large proportion of individuals affected remain undiagnosed and therefore without access to appropriate care and treatment.The most recent international statement on AATD was published by the American Thoracic Society and the European Respiratory Society in 2003. Since then there has been a continuous development of novel, more accurate and less expensive genetic diagnostic methods. Furthermore, new outcome parameters have been developed and validated for use in clinical trials and a new series of observational and randomised clinical trials have provided more evidence concerning the efficacy and safety of augmentation therapy, the only specific treatment available for the pulmonary disease associated with AATD.As AATD is a rare disease, it is crucial to organise national and international registries and collect information prospectively about the natural history of the disease. Management of AATD patients must be supervised by national or regional expert centres and inequalities in access to therapies across Europe should be addressed.
UHCW Research: Parr, D
α1-antitrypsin deficiency (AATD) is the most common hereditary disorder in adults. It is associated with an increased risk of developing pulmonary emphysema and liver disease. The pulmonary emphysema in AATD is strongly linked to smoking, but even a proportion of never-smokers develop progressive lung disease. A large proportion of individuals affected remain undiagnosed and therefore without access to appropriate care and treatment.The most recent international statement on AATD was published by the American Thoracic Society and the European Respiratory Society in 2003. Since then there has been a continuous development of novel, more accurate and less expensive genetic diagnostic methods. Furthermore, new outcome parameters have been developed and validated for use in clinical trials and a new series of observational and randomised clinical trials have provided more evidence concerning the efficacy and safety of augmentation therapy, the only specific treatment available for the pulmonary disease associated with AATD.As AATD is a rare disease, it is crucial to organise national and international registries and collect information prospectively about the natural history of the disease. Management of AATD patients must be supervised by national or regional expert centres and inequalities in access to therapies across Europe should be addressed.
UHCW Research: Parr, D
Thursday, 30 November 2017
Hypoglossal nerve stimulation for moderate to severe obstructive sleep apnoea [IPG598]
New interventional procedures guidance from NICE:
Current evidence on the safety and efficacy of hypoglossal nerve stimulation for moderate to severe obstructive sleep apnoea is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.
Current evidence on the safety and efficacy of hypoglossal nerve stimulation for moderate to severe obstructive sleep apnoea is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.
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